Successful appeals can actually lead to CMS policy changes. Facilities have been successfully appealing to receive Part B payments after a Medicare review contractor denied a Part A stay as not medically necessary. As a result, CMS is changing its policy on rebilling for Part B services.
Our experts answer questions about modifiers for diagnostic interventional procedures, Medicare recognition of CPT® code 9066, reporting add-on code for psychotherapy with interactive complexity, reporting G0378 for all payers, and wound care coding.
The AMA revised the molecular pathology codes in the CPT® Manual in 2012, but at that time CMS did not adopt the codes as it was still debating whether and how to change the reimbursement system for these services going forward. For CY 2013, CMS elected to recognize the codes, which meant it had to finalize how to pay for them. While CMS did not change pamyent for these services under the Clinical Laboratory Fee Schedule (CLFS) despite industry pressure, its change to the new codes means a change in the payments providers can expect this year and in the future.
CMS is making a significant change to the Medically Unlikely Edits (MUE) by changing some of them from line-item edits to date-of-service (DOS) edits, effective April 1.
Our experts answer questions about, modifier -25, cardioversion performed during an ED code, denials for multiple port film line items, and procedure discontinued after administration of anesthesia.
Editor's note: Facilities need to address coding, payment, and coverage issues for molecular pathology. This article is the first in a series and discusses molecular pathology coding.
